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. 2024 Jul 26;19(7):e0307162. doi: 10.1371/journal.pone.0307162

Influence of smartphone addiction on sleep quality of college students: The regulatory effect of physical exercise behavior

Weidong Zhu 1, Jun Liu 1, Hu Lou 1, Fanzheng Mu 1, Bo Li 1,*
Editor: Sohel Ahmed2
PMCID: PMC11280214  PMID: 39058670

Abstract

Due to the high incidence of smartphone addiction and its harmful effects on health in recent years, it has received widespread attention from society. This study aims to examine the association between smartphone addiction and sleep quality among college students, and assess the correlation with physical exercise in a non-interventional, cross-sectional study design. The study utilized data from the 2022 Chinese College Health Tracking Survey. A total of 4670 students participated in and completed the questionnaire. The test tools comprised the smartphone addiction tendency scale, the Pittsburgh Sleep Quality Index, and the physical activity rating scale. The average score of the college students’ smartphone addiction was 39.230±14.931, and the proportion of college students with average and or very poor sleep quality was 52.6%. Mobile phone addiction among college students is negatively correlated with physical exercise (r = -0.101, p<0.01), and positively correlated with sleep quality (r = 0.287, p<0.01. Physical exercise had a significant regulatory effect on the behavior relationship between smartphone addiction and sleep quality (ΔR2 = 0.194, p<0.001). Smartphone addiction has a significant impact on college students’ sleep quality. The higher the tendency towards smartphone addiction, the poorer the sleep quality of college students. Physical exercise plays a regulatory role in the relationship between smartphone addiction and sleep quality of college students.

1. Introduction

Mobile phone addiction refers to a new type of behavioral addiction in which individuals overuse smartphones to an uncontrollable extent, causing psychological, behavioral, and other problems to people [1]. According to the 51st Statistical Report on Internet Development in China, the number of Chinese netizens has reached 1.067 billion as of December 2022, of which young people aged 20–29 accounted for 14.2% [2]. With the improvement of living standards, electronic products such as smartphones, tablets, and laptops are increasingly used in the daily lives of Chinese college students. Students have spent more time in contact with smartphones due to online classes under the influence of the COVID-19 pandemic [3, 4]. At the same time, the development of technology also made electronic products such as smartphones more portable and convenient to access the internet, and the vast social world behind it often attracts college students to immerse themselves in the electronic virtual world [5].

In discussing the relationship between smartphone addiction and the sleep quality of college students, it is crucial to understand the characteristics of their stage in emerging adulthood. Emerging adulthood is a key developmental phase that involves the transition from adolescence to adulthood, during which individuals experience extended engagement in higher education, increased tolerance for premarital sex and cohabitation, and later ages of entering marriage and parenthood [6]. These changes grant them a self-focused freedom from role obligations and constraints, and satisfaction in progressing towards self-sufficiency [7]. However, the high degree of freedom and low societal role obligations at this stage may result in insufficient self-regulation in smartphone use. Excessive reliance on smartphones can not only impact their quality of life but may also lead to the development of mental health issues such as depressive symptoms and anxiety [8]. Therefore, devising effective intervention measures to reduce the negative impact of smartphone addiction is crucial for safeguarding the mental and physical health development of college students.

College students have more leisure time compared to adolescents and adults due to their special growth stage, making them a high-risk group for smartphone addiction. A study in Saudi Arabia found that the longer the use of smartphones, the deeper the dependence on it [9]. The media dependency theory also indicates that the longer the use of the media, the greater the impact it has on its users [10].

The correct use of smartphones can provide great convenience to college students’ study and life, but excessive addiction to smartphone use not only reduces sleep quality but also generates negative emotions, such as fatigue and procrastination [11, 12]. Some studies have shown that the harm caused by smartphone addiction mainly includes physical problems such as headaches, blurred vision, and neck pain [13]. On the one hand, smartphone addiction can reduce the time college students spend on physical exercise, thereby decreasing their physical fitness. On the other hand, excessive use of smartphones can lead to poor sleep quality among students. A study by Orzech found that more than 72.9% of college students use smartphones for more than one hour before going to bed [14]. Pham’s research also indicated that pre-sleep smartphone addiction has become an important factor affecting the sleep quality of college students [15]. Therefore, exploring the relationship between smartphone addiction and sleep quality among college students is greatly significant for their physical and mental health development.

Sleep plays an important role in the development of physical and psychological functions as part of a healthy lifestyle. Positive sleep quality is one of the necessary conditions for the development of individuals’ physiological and psychological functions [16]. However, smartphone addiction is one of the most important factors that has a negative impact on sleep quality [17]. As the main force of future development of the world, college students’ healthy development is related to the future of the world to some extent. Physical exercise is only considered as a measure to improve sleep quality, but few studies have explored the intrinsic relationship among smartphone addiction, sleep quality, and physical exercise. Early studies have indicated a significant correlation between smartphone addiction and a decline in sleep quality. For instance, researchers from Saudi Arabia have found that excessive smartphone use is associated with poor sleep quality [18]. A study from China has also revealed the negative impact of smartphone addiction on academic performance [19]. Additionally, there are studies indicating that smartphone addiction has a negative impact on sleep quality among the elderly population [20]. However, there is a lack of comprehensive perspective in the literature regarding how the level of physical activity might modulate this relationship.

In addition to the direct impacts related to smartphone addiction, physical activity is another important health behavioral factor that has been proven to positively correlate with sleep quality. Nonetheless, the interaction between smartphone addiction, physical activity levels, and sleep quality has not been fully explored in previous research. The intent of our study is to bridge this knowledge gap, with a particular focus on the unique population context in China. As one of the world’s largest markets for smartphones, understanding the specific circumstances of this region is crucial for a deeper comprehension and addressing of global health concerns. This study takes college students as the research object, and taking smartphone addiction and sleep quality as entry points and introducing physical exercise as a moderating variable (as shown in Fig 1). This study aims to explore the relationship between smartphone addiction and sleep quality under the regulation of physical exercise. The primary objectives of this study are as follows:(1)To describe the patterns and extent of smartphone addiction, sleep quality, and physical exercise among Chinese college students.(2)To investigate the relationship between smartphone addiction and sleep quality in college students.(3)To examine the role of physical exercise as a potential moderating mediator in the relationship between smartphone addiction and sleep quality in college students.

Fig 1. The conceptual model of this study.

Fig 1

2. Research methodology

2.1 Participants

This study adopted a cross-sectional research design, and eight questionnaire investigators were trained before the data collection, all of whom were undergraduate counselors from various colleges of Nantong University. Nantong University was established in 1912 and is located in Nantong City, Jiangsu Province, China. In the 2023 China University Evaluation by the China Academy of Management Sciences, it was ranked 102nd. The study utilized data from the 2022 Chinese College Health Tracking Survey, and the survey was conducted in September 2022. The participants were full-time freshmen, sophomores, juniors, and seniors of Nantong University. All students signed electronic informed consent forms before participating. All students signed an electronic informed consent form prior to participation. The participant demographics are shown in Table 1.

Table 1. Participant demographics.

Gender Grade
Male Female Freshman Sophomore Junior Senior
n(4670) 1714 2956 1606 1676 761 627
% 36.7 63.3 34.4 35.9 16.3 13.4

This study used a stratified random cluster sampling method, distributing 5,980 related questionnaires and receiving 4,670 valid questionnaires, with an response rate of 78%. The research plan was approved by the Ethics Committee of Nantong University (2022(70)). The minimum sample size was calculated using Formula (1) [21], where the Type I error α was set to 0.05, the allowable error δ was set to 0.01, and the sampling rate ρ was set to 0.05. Given that the total population of Yangzhou University is 48,209 people (updated data in 2023), the limited total population N was set at 75% of the student population, which is approximately 36,157 people. The calculated minimum sample size required for this study was 1,738 [22].

n=Zαδ2*p*1p1+Zαδ2*p*1p/N (1)

2.2 Measurement methods

2.2.1 Mobile Phone Addiction Tendency Scale (MPATS)

This study used the Mobile Phone Addiction Tendency Scale (MPATS) to measure mobile phone addiction among university students, which was compiled by Chinese scholars Xiong et al. [23]. MPATS comprises four dimensions: withdrawal symptoms, salience, social comfort, and mood changes, with a total of 16 items. Each item is scored using a five-point Likert scale: “completely not applicable,” “somewhat not applicable,” “neutral,” “somewhat applicable,” and “completely applicable,” for which the scores range from 1 to 5. The highest score is 80, and the lowest is 16. A higher score indicates a greater tendency for mobile phone addiction, while a lower score indicates a lower tendency. The factor loadings of the four dimensions range from 0.51 to 0.79, with an overall variance explained of 54.3%. The confirmatory factor analysis results show the applicability of the four-factor model. The Cronbach’s alpha coefficient of the total scale was 0.83, and the coefficients of the four factors ranged from 0.55 to 0.80. The test-retest reliability of the total scale was 0.91, while that of the four factors ranged from 0.75 to 0.85 [23]. The scale belongs to categorical variables.

2.2.2 Pittsburgh Sleep Quality Index (PSQI)

The sleep quality of the university students was measured by using the Pittsburgh Sleep Quality Index (PSQI). The PSQI was compiled by Dr. Buysse, a psychiatrist at the University of Pittsburgh, along with others in 1989. The PSQI is suitable for the evaluation of sleep quality and therapeutic efficacy observation of sleep disorder patients and mental disorder patients, investigation and study of sleep quality of general population, and the evaluation tool for the study of the correlation between sleep quality and psychosomatic health. The scale is more suitable for use by the Chinese population after Liu’s revisions. The scale comprises 23 items and is divided into seven components, each of which is scored on a scale of 0–3. The cumulative score of each component is the total PSQI score, which ranges from 0 to 21. The higher the total score, the worse the sleep quality becomes. The criteria for the total score are as follows: a score of 0–4 indicates good sleep quality, 5–7 indicates average sleep quality, and 8–21 indicates poor sleep quality [24]. The scale has good reliability and validity, with a Cronbach’s alpha coefficient of 0.764 [24]. The scale belongs to categorical variables.

2.2.3 Physical Activity Rating Scale-3 (PARS-3)

The Physical Activity Rating Scale-3 (PARS-3) was compiled by Japanese scholar Hiroo Hashimoto and revised by Chinese scholar Liang [25, 26]. The scale consists of three items, and each question in the scale is divided into five levels, with scores ranging from 1 to 5. The total score is highest at 100 and lowest at 0. with 0 indicating no physical activity and 100 indicating maximum physical activity. The score criteria are as follows: low exercise level (≤19 points), moderate exercise level (20–42 points), and high exercise level (≥43 points) [25]. The PARS-3 results are a measure of sports activities and can reflect the behavioral state of college students’ participation in sports at a specific time to some extent. Domestic research shows that the internal consistency reliability coefficient of the scale is 0.856, while the retest reliability coefficient is 0.820 [25]. The scale belongs to categorical variables.

2.3 Statistical analysis

Data processing was conducted by using IBM SPSS Statistics 26.0 and WPS Excel software(11.1.0.14309), which consisted of the following four steps: (1) Use Excel software to preprocess the data obtained from the questionnaire, and retest or delete the missing or problematic data. (2) After preprocessing the data, conduct a general analysis of the collected student data. The analysis content comprises sleep quality and physical exercise status. The Chi-square test was used to analyze the differences in physical exercise and sleep quality among students of different genders and grades. One-way ANOVA was used to analyze the differences between sleep quality and physical exercise in male and female university students of various grades based on the effect size, η2. (3) A correlation analysis was performed to examine the correlation between the tendency of mobile phone addiction among university students (including withdrawal symptoms, highlight behavior, social comfort, and mood changes) and physical exercise, as well as sleep quality. (4) A linear regression analysis was used to test the effect of mobile phone addiction on sleep quality among university students, with physical exercise included as a moderating variable. Before calculating the moderation effect, the variables (Z-score) were standardized.

3. Research findings

3.1 General trends

Table 2 shows that the proportion of male students who engaged in moderate (21.4%) and high levels (25.3%) of physical exercise was much higher than that of female students who engaged in moderate (9.5%) and high levels (4.9%) of physical exercise. Moreover, there was a significant difference in physical exercise between male and female students (p < 0.001, Cramer’s V = 0.365). From a grade perspective, a significant difference exists in physical exercise among university students in different grades (p < 0.001, Cramer’s V = 0.080). The number of freshmen who had good sleep quality (52.4%) was significantly higher than that of students in other grades. No significant difference exists in sleep quality between male and female students (p = 0.240, Cramer’s V = 0.400), but a significant difference exists in sleep quality among university students in different grades (p <0.001, Cramer’s V = 0.770).

Table 2. General situation of physical exercise and sleep quality among college students.

Total (n = 4670) Male (n = 1714) Female(n = 2956) Freshman(n = 1606) Sophomore(n = 1676) Junior(n = 761) Senior(n = 627)
n % n % n % n % n % n % n %
Physical Exercise
Low exercise level 3443 73.7 915 53.4 2528 85.5 1122 69.9 1284 76.6 579 76.1 458 73
Moderate exercise level 648 13.9 366 21.4 282 9.5 258 16.1 221 13.2 79 10.4 90 14.4
High exercise level 579 12.4 433 25.3 146 4.9 226 14.1 171 10.2 103 13.5 79 12.6
X2 622.538 29.636
p <0.001 <0.001
Cramer’s V 0.365 0.080
Sleep quality
Fairly good 2213 47.4 825 48.1 1388 47 842 52.4 726 43.3 336 44.2 309 49.3
Average 1745 37.4 603 35.2 1142 38.6 580 36.1 685 40.9 273 35.9 207 33
Very poor 712 15.2 286 16.7 426 14.4 184 11.5 265 15.8 152 20 111 17.7
X2 7.460 55.555
p 0.240 <0.001
Cramer’s V 0.400 0.770

In Table 3, it can be seen that there was no significant difference in mobile phone addiction between male and female students (F = 0.240, p = 0.624, η2 <0.001). However, a significant difference exists in mobile phone addiction among university students in different grades (F = 17.998, p<0.001, η2<0.001).

Table 3. Descriptive analysis of electronic addiction and physical exercise among college students.

Gender Grade
Total (n = 4670) Male (n = 1714) Female (n = 2956) Freshman (n = 1606) Sophomore (n = 1676) Junior (n = 761) Senior (n = 627)
M sd M sd M sd P η2 M sd M sd M sd M sd P η2
Mobile addiction total score 39.23 14.93 39.37 15.66 39.15 14.49 0.62 <0.001 37.14 12.96 40.51 14.90 40.91 16.86 39.14 16.54 <0.001 0.01
Withdrawal symptoms 15.94 5.82 15.94 6.01 15.95 5.71 0.94 <0.001 15.48 5.32 16.29 5.75 16.37 6.41 15.70 6.38 <0.001 0.01
Highlight behavior 8.69 4.04 8.93 4.27 8.54 3.89 0.00 0.002 7.78 3.42 9.18 4.07 9.34 4.54 8.90 4.36 <0.001 0.03
Social comfort 7.71 3.32 7.63 3.39 7.75 3.28 0.26 <0.001 7.45 3.21 7.89 3.20 7.92 3.56 7.62 3.54 <0.001 0.00
Mood changes 6.90 3.14 6.87 3.25 6.91 3.08 0.72 <0.001 6.43 2.82 7.15 3.13 7.29 3.48 6.93 3.39 <0.001 0.01

3.2 Correlation analysis

Table 4 indicates a significant correlation (P<0.01) between mobile phone addiction and sleep quality among college students, with dimensions ranging from 0.255 to 0.287. Additionally, a significantly negative correlation (P<0.01) exists between sleep quality and physical exercise, with a correlation coefficient of -0.037. A significant difference (P<0.01) exists between physical exercise and mobile phone addiction, with dimensions ranging from -0.084 to -0.112. All the variables involved in Table 4 are categorical variables.

Table 4. Correlation analysis results.

withdrawal symptoms Highlight behavior social comfort mood changes Mobile addiction total score Physical exercise total score
withdrawal symptoms
Highlight behavior 0.652**
social comfort 0.596** 0.560**
mood changes 0.649** 0.672** 0.569**
Mobile addiction total score 0.829** 0.771** 0.704** 0.760**
Physical exercise total score -0.084** -0.092** -0.112** -0.095** -0.101**
PSQI total score 0.255** 0.284** 0.255** 0.283** 0.287** -0.037**

** stands for p < 0.001.

3.3 Test for moderating effects

Table 5 presents the results of the effect of sports exercise regulation. Model 1 shows that with sleep quality as the dependent variable, the explanation rate of independent mobile addiction and regulating sports exercise variables is 18.9%. In Model 2, the predictive ability improved by 19.4%, meaning that the contribution rate of regulating effect is 19.4% under the condition that mobile addiction independent variable and sports exercise regulation variable remain unchanged. In addition, the significant F change in both models is less than 0.001. The mobile addiction independent variable and sports exercise regulation variable have a significant impact on the sleep quality dependent variable. In the analysis of variance, the P value is less than 0.001, indicating that the regulatory effect of sports exercise regulation variable on the mobile addiction independent variable is significant. Therefore, sports exercise is a regulatory factor for mobile addiction and sleep quality.

Table 5. Results of moderating effects.

Summary table of model ANOVA
Model R2 ΔR2 df1 df2 Sig. F Change F P
1 0.189 0.189 1 4668 <0.001 1086.561 <0.001
2 0.195 0.194 1 4667 <0.001 564.113 <0.001

Note: Model 1 employs sleep quality as the dependent variable in the analysis model.

Model 2 assesses the predictive ability of the combined effect of mobile addiction and the regulatory effect of sports exercise beyond Model 1.

4. Discussion

Sleep quality is becoming increasingly important for people’s physical health in today’s fast-paced life. The research object of this paper is Chinese college students. Through the investigation and analysis of their data, we explore the internal relationship among smartphone addiction, sleep quality and physical exercise. The score of smartphone addiction among university students is 39.23±14.93. Approximately 51.9% of university students have average or poor sleep quality. Smartphone addiction among university students is negatively correlated with physical exercise and positively correlated with sleep quality. Physical exercise has a significant moderating effect on the relationship between smartphone addiction and sleep quality. Smartphone addiction among university students has a significant impact on sleep quality. The higher the tendency of smartphone addiction, the poorer the sleep quality of university students. Physical exercise plays a moderating role in the relationship between smartphone addiction and sleep quality among university students.

4.1 Analysis of the variability in physical exercise among college students

The proportion of male university students with moderate and high exercise levels is much higher than that of female university students. This is consistent with the findings of a previous study from the United States. Trevor Egli MS determined that the main factors driving exercise motivation among American male college students are strength, competition, and challenge, while the main factors driving exercise motivation among American female college students are weight management and appearance [27]. We believe that the reason for this phenomenon in China may be that the exercise motivations of different genders of college students have changed. Chinese male university students engage in moderate and high exercise levels more often, to pursue strength, competition and challenge, and thus most of them choose high-intensity exercise. The feudal society in China for thousands of years has given women the stereotypical label of quiet, gentle and peaceful, which has not been completely removed. Today, the aesthetic pursuit of women in China is based on to be thin for beauty, wherein more female university students engage in low-intensity aerobic exercise to maintain their beauty of body shape, which may be the reason why there are differences in physical exercise among Chinese university students based on gender.

This study found that there were significant differences in physical exercise among university students in different grades. This is consistent with Wu’s research [28], which found that senior students face with graduation and future career or study planning, and can only spend less time on physical exercise. The proportion of students in the first year engaging in moderate and high levels of exercise was slightly higher than that of students in the second, third, and fourth years. However, the proportion of freshmen was significantly lower than that of sophomore, junior, and senior students in terms of low-intensity exercise. We believe that the reasons for this phenomenon may be related to the education system in Chinese universities. students in the first year have less academic pressure and apart from the daily class time, they have no worries about other things. They have sufficient time for physical exercise without worrying about the lack of physical and mental strength which will affect other affairs. However, in the second, third, and fourth years, students not only face academic pressure, but the pressure of future career planning, further education and other aspects, which make them begin to use their extracurricular time to make up for their deficiencies. Therefore, students turn to low-intensity exercise to minimize physical exertion. In fourth year, the proportion of students engaging in moderate and high levels of exercise is higher than that of the second and third years. The reason for this may be that some fourth-year students have found jobs or obtained qualifications for further education, leading to an increase in the proportion of students engaging in moderate and high levels of exercise. This pressure is particularly prominent during the pandemic [29]. Additionally, it is crucial to understand that university students in China are in a critical evolutionary phase of transitioning from adolescence to adulthood, a period characterized by significant psychological and lifestyle changes [30]. This transition phase influences not only their academic and professional choices but also impacts their psychological well-being and daily behaviors including exercise habits. Undergraduate education in Chinese universities lasts only for four years (except for medical majors), and three out of the four years of college students enrolled in 2019 have been affected by the pandemic. Their schools cannot guarantee normal teaching, which leads to a lack of solid mastery of professional knowledge and skills, greatly increasing the students’ pressure for the future. Therefore, most sophomore and junior students chose low-intensity exercise to ensure that they have sufficient time and energy to study.

4.2 Analysis of the differences in sleep quality among college students

This study determined that 51.9% of Chinese university students had problems with sleep quality. This is consistent with Hu’s research result, which found that more than half of the sample had sleep problems [31]. According to previous studies, long-term use of mobile phones and less physical exercise may be associated with poor sleep quality among university students [32].WANG suggested that university students’ sleep quality is susceptible to different risk factors, and the main determinants need to be considered when designing interventions to improve their sleep quality [33]. The university students’ sleep quality can be affected by various factors, and with the development of technology, smartphone addiction has gradually become an important factor affecting university students’ sleep quality [34]. This study mainly explores the influence of smartphone addiction on university students’ sleep quality, and smartphone addiction is considered as the main risk factor to investigate. Elizabeth B. Dowdell reported that a quarter of college students have a habit of using smartphones before sleep, which is associated with memory decline. Moreover, the trend of using smartphones before sleep shows an increasing tendency among college students [35]. Bartel, K study also mentioned that restricting the use of mobile phones in young people would enable them to sleep longer and have higher sleep quality [36]. All aforementioned studies have proved that smartphone addiction has an impact on sleep quality.

No significant gender differences exist in sleep quality among university students. This is different from previous studies where gender differences were found to play an important role in sleep quality, with higher sleep problem rates among females [37]. However, Zhang’s research found that sleep quality among East Asian women was better than that of women in other regions of the world [38]. This phenomenon may be related to cross-regional cultural differences. In terms of grade level, the sleep quality of freshmen was significantly better than that of students in the other three grades, which is related to the education system in China. In high school, Chinese students face heavy academic pressure, and the prevalence of sleep problems among Chinese high school students was 42.3%, according to Cao’s research [39]. However, in university, the decrease in academic pressure in the first year leads to an increase in students’ sleep time and improvement in sleep quality. However, students begin to consider their own development and future plans starting from second year, and the increasing pressure forces them to sacrifice more time in academic and skill learning. Therefore, from the data, it can be observed that the proportion of university students with poor sleep quality decreased significantly from first to third year. The reason for the improvement in sleep quality of senior students is that some of them have already found jobs with graduation approaching, and they no longer have to worry about academic and graduation pressures. Therefore, the sleep quality of students in this phase begins to improve.

4.3 Analysis of the variability in mobile phone addiction among college students

No significant difference exists in mobile phone addiction between students of different genders. This is different from previous studies which indicated that females are more susceptible to mobile phone addiction [40, 41]. However, no difference exists in this paper. The possible reason for this may be that the epidemic has led to a decrease in the entertainment methods of college students. Frequent online classes, school closures and dormitory lockdowns have forced college students to spend more time indoors [42]. During this period, mobile phones became the most convenient way for communication and entertainment for students, regardless of their gender, which led to the result that no difference exists in mobile phone addiction between male and female students in this study.

A significantly positive correlation exists between the four dimensions of mobile phone addiction in college students (withdrawal symptoms, salience, social comfort, and mood changes) and their sleep quality scores. A higher score on the PSQI represents lower sleep quality, which means that the higher the degree of mobile phone addiction among college students, the worse their sleep quality would be, which is consistent with the findings of Fengd’s study [43]. From December 2019 to December 2022, under the impact of COVID-19, China implemented normalized prevention and control policies, which forced many universities to adopt online teaching measures once positive cases were found in the cities where they were located. If students were in close contact with positive cases on campus, they had to undergo a seven-day home quarantine. In quarantine, smartphones became their only means of communication and information acquisition with the outside world. Social interaction is a universal basic human motivation [44]. Saadeh and H’s research investigation found that 85% of people in quarantine increased their mobile phone usage during the isolation period, with 42% using their phones for more than 6 hours per day [45]. Long-term quarantine can provide strong psychological pressure. Therefore, in long-term medical isolation situations, corresponding measures must be taken to ensure the psychological health of the quarantined individuals, avoiding negative mental problems. Previous studies have shown that sleep quality is influenced by many factors, such as lifestyle, environmental factors, work conditions, social life, economic conditions, physical health status, stress, and so on [46]. Mobile phone addiction, as an environmental factor, has a negative impact on sleep quality [4749], which is consistent with the results of the correlation analysis in this study. Poor sleep quality can lead to depression and stress [50], affecting the health of college students in a significant negative way [51, 52]. Therefore, Chinese universities should take measures to reduce the use of smartphones by students.

4.4 Correlation discussion

A significantly negative correlation exists between the total score of college students’ physical exercise level and their sleep quality, indicating that physical exercise may improve college students’ sleep quality [53, 54]. In Dolezal’s study, regardless of the type and intensity of physical activity, exercise can improve subjective sleep quality [54]. Physical exercise promotes the college students’ physical and mental health. Severe mobile phone addiction is a psychological illness, and physical exercise has a significant positive impact on psychological improvement [55]. Physical exercise can reduce the impact of psychological stress on emotional states, promote emotional health [56], and provide a sense of fulfillment and satisfaction. Through physical exercise, college students can increase knowledge, develop skills, and feel a sense of fulfillment [57], which can enable them to focus their attention on real-life rather than seeking fulfillment in the virtual world.

4.5 Moderating effect discussion

Through the analysis of the moderating effect, physical exercise has a significant moderating effect on the impact of mobile phone addiction on college students’ sleep quality. From a physiological perspective, the long-term use of smartphones by college students increases the amount of microwave radiation that the body receives. The central nervous system is the most sensitive target for microwave radiation. Therefore, microwave radiation’s impact on the human body is primarily through the nervous system [58]. The main cause of neurasthenia syndrome caused by electromagnetic radiation from smartphones is long-term close contact with the body [59]. This may be the reason why sleep quality is affected by mobile phone addiction. However, an explosion of information exists in today’s society, and smartphones are the most economical, convenient, and fastest way for college students to obtain external information. Continuous theory holds that the brain’s mental activity is continuous, and dreams at night unconsciously reflect daytime activity [60]. It is also important to consider that university students are in a crucial developmental phase transitioning from adolescence to adulthood, characterized by significant psychological and lifestyle changes. This transition not only influences their academic and career choices but also their sleep patterns and behaviors, including smartphone use [61]. During the COVID-19 epidemic, the most common information college students obtained through short videos was related to the epidemic, increasing their anxiety. Therefore, prolonged use of smartphones can cause college students to unconsciously recall the information they searched for about the epidemic during the day [62], which is also one of the reasons for poor sleep quality in college students. Understanding the developmental stage of university students can provide additional context to analyze how factors like smartphone addiction impact their sleep quality.

The significant moderating effect of physical exercise on sleep quality in college students may be due to the following reasons: (1) When college students engage in physical exercise, they reduce the time of using smartphones, which reduces the impact of microwave radiation on their central nervous system [58]. (2) Through physical exercise, college students gain a sense of fulfillment and satisfaction, reducing their need to seek fulfillment in the virtual world of smartphones [63]. (3) Physical exercise can release the stress that college students experience in their studies and daily life, thus improving their sleep quality [64].

The limitations of this study comprise the following: (1) Mobile phone addiction is caused by multiple factors, and there are many interfering factors in the exploration process. The impact of each variable must be explored through quasi-experimental and longitudinal studies, which can be future research directions. (2) The scope of the investigation needs to be further expanded, and the research subjects should be representative to verify the universality and rationality of this study. (3) This study only discusses the impact mechanism of physical exercise on mobile phone addiction and sleep quality, without delving into the discussion of causal relationships. (4) The study did not collect information on participant characteristics and potential confounding factors during data collection, which is a limitation of this study.

5. Conclusion

The proportion of university students with sleep quality problems is 51.9%, which may be related to the degree of mobile phone addiction. The proportion of male university students who engage in moderate and high levels of exercise is much higher than that of female university students, and this phenomenon may be due to differences in exercise motivation. Mobile phone addiction among university students is negatively correlated with physical exercise and positively correlated with sleep quality. The more severe the mobile phone addiction among university students, the worse their sleep quality would be. Physical exercise can significantly regulate the adverse effects of mobile phone addiction on sleep quality among university students. Although the sample size of this study is concentrated in a single school, the students admitted to this school come from different provinces and regions. Therefore, there are variations in lifestyle habits and practices, which to some extent reduces the limitations of the study. The data can provide theoretical support for improving the sleep quality of university students.

Supporting information

S1 Data

(SAV)

pone.0307162.s001.sav (170KB, sav)

Acknowledgments

We are grateful to the participants and their universities for the cooperation and participation in this study.

Data Availability

All relevant data are within the manuscript and its Supporting information files.

Funding Statement

This work was supported by: Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX24_3498), received by Weidong Zhu The General Project of Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province. “Research on the promotion of physical and mental health of college students based on the improvement of physical literacy” (No: 2024SJYB1253), received by Bo Li National Social Science Fund “14th Five-Year Plan” General Project in the field of Education for the year 2021 (BLA210215), received by Hu Lou Key Project of Jiangsu Provincial Education Science Planning (B/2022/01/173), received by Bo Li.

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Decision Letter 0

Md Saiful Islam

14 Aug 2023

PONE-D-23-21239Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise BehaviorPLOS ONE

Dear Dr. li,

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Reviewers' Comment

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1.Your English writing needs further improvement. The language in submitted articles must be clear, correct, and unambiguous.

2.Your paper layout needs further beautification. For example, formula (1) is too large for the paper.

Reviewer #2: Thank you for giving me the opportunity for this review.

This study examined the effect of smartphone addiction on sleep quality in a single university in China, taking into account exercise behavior. Smartphone addiction is an emerging social issue and this study deals with an important public health topic.

While the results presented are common sense and valid, the quality of this study is low and the data does not seem to corroborate the results presented with a high degree of accuracy.

There are several major issues with this study. First, this is a cross-sectional study, and the study design does not allow for reference to causal relationships. Second, the study participants were students affiliated with a single university, making the study less representative. Third, the analysis only identified simple correlations and did not adjust for several potential confounders.

Participants

1. The authors should provide an overview of Nantong University so that readers can assess representativeness.

2. The authors should describe the study participants in detail, including in the text and a table.

3. The authors should provide an in-depth discussion of one of the major limitations of this study, representativeness, in the discussion section.

4. I did not understand the description of the sample size calculation method.

Measurement Methods

5. The authors should provide a table of data on study participant characteristics, such as obesity rate, smoking and alcohol consumption rates, and potential confounders that may influence the relationship between smartphone addiction and sleep, such as academic achievement, financial ability, commuting time to university, and living environment, if they measured these factors.

6. If the authors did not have access to the characteristics and potential confounders of the study participants, this should be noted in the discussion section as a limitation of the study.

7. The authors should cite the original article on the physical activity assessment study.

Statistical Analysis

8. The authors should adjust for confounders using multivariable analysis methods.

Reviewer #3: In this study, the authors investigate the influence of smartphone addiction on the sleep quality of college students: the regulatory effect of physical exercise behavior. The study draws attention with its sample size. My concerns about the study are listed below.

As the authors know, there are many studies conducted in this area (33. Sahin S, Ozdemir K, Unsal A, Temiz N. Evaluation of mobile phone addiction level and sleep quality in university students. Pak J Med Sci. 2013;29(4):913-8. doi: 10.12669/pjms.294.3686. PubMed PMID: WOS:000322619000005.)

More up-to-date resources in WOS could have been used (Buke, M., Egesoy, H., & Unver, F. (2021). The effect of smartphone addiction on physical activity level in sports science undergraduates. Journal of bodywork and movement therapies, 28, 530-534).

The concept of hypothesis is misused. H1-H2-H3 were questions that the authors sought answers to.

Mobile Phone Addiction Tendency Scale (MPATS) and Physical Activity 151 Rating Scale-3 (PARS-3) should be included in the summary.

Spelling and punctuation in the text should be checked. Use the dot after the closed parenthesis.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Jul 26;19(7):e0307162. doi: 10.1371/journal.pone.0307162.r002

Author response to Decision Letter 0


14 Oct 2023

Dear Editors and Reviewers:

Thank you for your letter and the reviewer’s comments regarding our manuscript, “Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise Behavior”(PONE-D-23-21239).These comments have been invaluable and helpful in revising and improving our paper, as well as important guidance for our research. We have carefully studied these comments and made revisions, which we hope will be recognized. The revised parts are highlighted in red in the paper. The corrections in the paper and the responses to the reviewer’s comments are as flowing:

Reviewer #1: 

1.Your English writing needs further improvement. The language in submitted articles must be clear, correct, and unambiguous.

Response:We recognize your concern for the clarity and correctness of our English writing. We apologize for any ambiguities or errors that may have occurred. As a result, we have sought the assistance of a professional academic editing agency to ensure the accuracy and fluency of the language in this revision. We will be working closely with them to meticulously proofread and revise the paper.Thank you for your suggestion, and we will strive to ensure the language quality of the paper, as evidenced by the proof of editing provided below.

2.Your paper layout needs further beautification. For example, formula (1) is too large for the paper.

Response:We appreciate your feedback on the layout of our paper. We understand that the font size of Equation (1) is too large, making the article aesthetically unappealing. We will carefully adjust the font size and formatting to ensure that all formulas and charts are visually appealing while maintaining readability. Thank you for your suggestion, and we will strive to make improvements accordingly.

Reviewer #2:

1.This is a cross-sectional study, and the study design does not allow for reference to causal relationships.

Response:Thank you for your review and valuable feedback on our research titled "Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise Behavior" We greatly appreciate your comments and suggestions regarding the quality of research and data analysis.

We only discussed potential mechanisms of influence and did not include a discussion of causality in this research program. Additionally, we provided an explanation of the limitations of our study in the discussion section.

Thank you for your valuable feedback once again.

2. The study participants were students affiliated with a single university, making the study less representative.

Response:Thank you very much for your question about the representativeness of the sample. Although the participants in this study all come from the same university, they represent different majors and come from various provinces, cities and counties across China. Nonetheless, we recognize that the sample still has certain limitations and cannot fully represent the entire Chinese college student population.. For future studies, we will consider expanding the sample size and covering more schools and districts to improve the representativeness of the study. Thank you for your reminder and feedback.

3.The analysis only identified simple correlations and did not adjust for several potential confounders.

Response:Thank you very much for your question. This study only addresses the mechanisms of the moderating effects of physical exercise behavior and does not include explanations regarding confounding factors. Thank you for your question.

Participants

1. The authors should provide an overview of Nantong University so that readers can assess representativeness.

Response:Thank you very much for your feedback. We have included line numbers 103-106 in the article to provide additional information on the location and background of Nantong University, as well as when it was founded and its position in the education system in order to provide readers with a better understanding of the basics of Nantong University. Thank you for your suggestion.

2. The authors should describe the study participants in detail, including in the text and a table.

Response:Thank you very much for your question. We have added Table 1, which presents the sample distribution, and detailed textual explanations in lines 110-113 of the article. so that readers can have a more detailed understanding of the basic information of the study participants. We appreciate your suggestion and have made the necessary modifications.

3. The authors should provide an in-depth discussion of one of the major limitations of this study, representativeness, in the discussion section.

Response:Thank you very much for your question. We will discuss the representativeness of the sample in the discussion section. This can be found at lines 428-431 of the article.

4. I did not understand the description of the sample size calculation method.

Response:Thank you very much for your question about the sample size calculation method. The calculation method used in this article is based on the approach mentioned in the literature by Chinese scholar Shao Zhiqiang. In this method, α corresponds to the formula zα, and α is generally set to 0.05. For a two-tailed test, z0.05 is 1.96, and for a one-tailed test, z0.05 is 1.64. δ represents the allowable error, which is usually determined based on experience and should not be too large. p represents the prevalence, which is the overall population prevalence and is typically set at 0.05. The finite population size N depends on the target population, such as the total number of students in a school or patients in a hospital.

Measurement Methods

5. The authors should provide a table of data on study participant characteristics, such as obesity rate, smoking and alcohol consumption rates, and potential confounders that may influence the relationship between smartphone addiction and sleep, such as academic achievement, financial ability, commuting time to university, and living environment, if they measured these factors.

Response:Thank you very much for your question. As the questionnaire did not collect data on factors such as obesity rate, smoking and drinking rates, academic achievement and financial ability , this will be noted in the limitations of this study.

6. If the authors did not have access to the characteristics and potential confounders of the study participants, this should be noted in the discussion section as a limitation of the study.

Response:Thank you very much for your question. Since this article did not collect detailed data on features and confounding factors during data collection, we will point this out in the limitations of the discussion section,lines413-417.

7. The authors should cite the original article on the physical activity assessment study.

Response:Thank you very much for your question. We will add the original reference from Japanese scholar Hashimoto Kimio to the section on the sports activity level scale in section 2.2.3.

Statistical Analysis

8. The authors should adjust for confounders using multivariable analysis methods.

Response: Thank you very much for your question. This study only focuses on the regulatory mechanisms of physical exercise and does not involve explanations regarding confounding factors. Thank you for your question.

Reviewer #3: In this study, the authors investigate the influence of smartphone addiction on the sleep quality of college students: the regulatory effect of physical exercise behavior. The study draws attention with its sample size. My concerns about the study are listed below.

1.As the authors know, there are many studies conducted in this area (33. Sahin S, Ozdemir K, Unsal A, Temiz N. Evaluation of mobile phone addiction level and sleep quality in university students. Pak J Med Sci. 2013;29(4):913-8. doi: 10.12669/pjms.294.3686. PubMed PMID: WOS:000322619000005.)

More up-to-date resources in WOS could have been used (Buke, M., Egesoy, H., & Unver, F. (2021). The effect of smartphone addiction on physical activity level in sports science undergraduates. Journal of bodywork and movement therapies, 28, 530-534).

Response: Thank you very much for your guidance. We have replaced reference 33 in this study.

2.The concept of hypothesis is misused. H1-H2-H3 were questions that the authors sought answers to.

Response: Thank you very much for your question. This study will exclude the hypothesis section and only focus on seeking answers to the questions proposed by H1-H2-H3.

3.Mobile Phone Addiction Tendency Scale (MPATS) and Physical Activity 151 Rating Scale-3 (PARS-3) should be included in the summary.

Response: Thank you very much for your question. We will add the Mobile Addiction Tendency Scale and the Physical Activity Level Scale in the abstract, specifically at line number 31-33.

4.Spelling and punctuation in the text should be checked. Use the dot after the closed parenthesis.

Response: Thank you very much for your question. We have carefully checked the spelling and punctuation in the manuscript again. We have also sought assistance of a professional proofreading agency to ensure the coherence and correctness of the language in the article.

Attachment

Submitted filename: Response to Reviewers.docx

pone.0307162.s002.docx (157.5KB, docx)

Decision Letter 1

Giulia Ballarotto

6 Feb 2024

PONE-D-23-21239R1Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise BehaviorPLOS ONE

Dear Dr. li,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

I saw the comments of the reviewers, both in the previous round of review and in the present one. Some comments are somewhat conflicting, but I believe, based on their judgments, that there are minor changes that could be made to improve the work. I therefore invite you to further revise the paper, which can improve a lot if you follow these suggestions.

Please submit your revised manuscript by Mar 22 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

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Giulia Ballarotto

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Partly

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: In this study, the authors investigate the influence of smartphone addiction on the sleep quality of college students: the regulatory effect of physical exercise behavior.

The authors have completed the necessary corrections.

Kind regards

Reviewer #4: Abstract:

"explore its regulating effect by introducing physical exercise" This refer as if the study an interventional one. Please rephrase in a way that make it a cross sectional study.

"r=-0.101", here do you mean r-squared of the regression? if not, please report r-squared instead of r value.

Introduction:

-"problems to people.[1]" please adjust the reference style.

- "generates negative emotions, such as fatigue and procrastination." where is the reference?

- "The current study on smartphone addiction mainly focus on mental health and

hygiene", Do you mean your study? Do you mean mental hygiene? Clarify please.

- Please include studies that previously assessed the relationship between smartphone addiction and sleep quality (such as https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9879389/), and those also assessed physical activity and its effect on sleep quality? Is there any study in China? Please highlight in the introduction to clarify the gap in knowledge.

- "What are the characteristics of contemporary college students' smartphone addiction, sleep quality, and physical exercise?" This is not the correct way to write a scientific hypothesis. In fact, the all the of them need to be rewritten or to change it into study objective.

-remove the word contemporary and rephrase the sentence.

Methods:

- "The scales used in the" do you mean questionnaire? replace.

- "effective rate of 78%." change it into response rate.

- "Given that the total population is 48,209 people" the total population of all university students in China, or in that university or what? if you have the reference that will be great.

Research Findings

- please include a table about demographic data of the participants.

- Also, I think you have to put a descriptive statistics to all the variables, in continuous and categorical format before going into analysis. This will answer the research hypothesis number 1 in your research.

- Table 1 design is little confusing, I wish you can adjust it so it can be read easily. For example, you have in the row three sections total, gender and academic year, so please make that clear.

- Table 2 is so confusing with the numbers, please either change the layout, or use 1 or 2 decimals maximum in the table. Remove F-value, as it is confusing.

- In Table 4 please put footnote for what model 1 include, and what model 2 include.

- In Table 4 please clarify if you used the data in its continuous format or categorical one, because that was not clear to reader.

Discussion:

- "previous studies[16]." in what country?

-"Trevor Egli MS" do you mean that this is reference 16 please put the reference here.

- In discussion from line 248-258, they were written without reference, if this is the author opinion, I think you should write, it is suggested or similar terms. This is applied to many parts in the discussion, where many sentences without reference. So I suggest that write what make it clear that this is your suggestion

- Your discussion is long, and I think you need to make subheading for it.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #3: No

Reviewer #4: No

**********

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Jul 26;19(7):e0307162. doi: 10.1371/journal.pone.0307162.r004

Author response to Decision Letter 1


12 Feb 2024

Dear Editors and Reviewers:

Thank you for your letter and the reviewer’s comments regarding our manuscript, “Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise Behavior”(PONE-D-23-21239).These comments have been invaluable and helpful in revising and improving our paper, as well as important guidance for our research. We have carefully studied these comments and made revisions, which we hope will be recognized. The revised parts are highlighted in red in the paper. The corrections in the paper and the responses to the reviewer’s comments are as flowing:

Reviewer #4: Abstract:

"explore its regulating effect by introducing physical exercise" This refer as if the study an interventional one. Please rephrase in a way that make it a cross sectional study.

Response: Thank you for your insightful comments and for emphasizing the need for clarity regarding our study design. As you have correctly pointed out, the original wording suggested an interventional approach, which was not in line with the intent of our study.

I have revised the language in the manuscript to more accurately convey that our research is a cross-sectional analysis. We have rephrased the purpose of our study to underscore the examination of associations rather than implying any intervention. Moreover, I have highlighted the correlation between physical exercise and the relationship between smartphone addiction and sleep quality to further clarify that our study design is observational in nature.

I hope these modifications address your concerns and faithfully communicate the cross-sectional nature of our study. Please feel free to make any further suggestions if necessary. For these changes, please refer to lines 26-30.

"r=-0.101", here do you mean r-squared of the regression? if not, please report r-squared instead of r value.

Response: Thank you for your inquiry. The "r=-0.101" mentioned here refers to the correlation coefficient result, not the r-squared value of the regression. You can find the report on r-squared in lines 37 to 39 of the revised manuscript. Should you have any further questions or require additional information, please feel free to let me know.

Introduction:

-"problems to people.[1]" please adjust the reference style.

Thank you for bringing this to my attention. I have corrected the reference style as per your suggestion. The updated reference can now be found in the revised manuscript at line number 49.

- "generates negative emotions, such as fatigue and procrastination." where is the reference?

Response:Thank you for your question and for pointing out the oversight. We have added the appropriate reference for this statement. Please refer to line 67 of the revised manuscript for the specific correction and the added citation. If there are any other concerns or clarifications needed, do not hesitate to contact us.

- "The current study on smartphone addiction mainly focus on mental health and

hygiene", Do you mean your study? Do you mean mental hygiene? Clarify please.

Response:Thank you for seeking clarification. When I referred to "The current study on smartphone addiction mainly focus on mental health and hygiene," I was intending to summarize the general trend of research in the area of smartphone addiction. Upon further examination, we recognized that there is insufficient evidence in the literature to substantiate the focus on mental health and hygiene specifically in relation to smartphone addiction. Consequently, we have opted to eliminate this statement from our manuscript to ensure accuracy. This change can be found in the revised version, where lines 67-69 have been removed.

- Please include studies that previously assessed the relationship between smartphone addiction and sleep quality (such as https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9879389/), and those also assessed physical activity and its effect on sleep quality? Is there any study in China? Please highlight in the introduction to clarify the gap in knowledge.

Response: Thank you for your insightful comments and your suggestion to include prior studies that assessed the relationship between smartphone addiction and sleep quality, as well as the intersection of physical activity and its effect on sleep quality.

In response to your request, I will enrich the introduction section by discussing several pivotal studies that have investigated these important themes. For example, I will reference the study you provided (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9879389/), which offers a comprehensive analysis of how excessive smartphone use may detrimentally affect sleep quality.

Furthermore, I will make an effort to highlight research conducted in China regarding this topic. Indeed, scholars in China have undertaken numerous studies examining the effects of smartphone addiction on various aspects of health and daily life, including sleep quality. I will identify and include relevant Chinese studies to underline the existing research in the area, which will help to illustrate the current gap in knowledge that our study aims to address.

By integrating these studies, the introduction will clearly state the contribution of our research within the broader context of existing literature. This will not only fortify the backdrop against which our study stands but will also elucidate the necessity for further research to bridge the knowledge gap identified.For the relevant revisions, please refer to lines 86-92.

- "What are the characteristics of contemporary college students' smartphone addiction, sleep quality, and physical exercise?" This is not the correct way to write a scientific hypothesis. In fact, the all the of them need to be rewritten or to change it into study objective.

Response: Thank you for your keen observation regarding the construction of our research questions and hypotheses. Upon reflection, we concede that the initial formulation of our hypotheses more closely resembled questions, which could lead to misinterpretation and are not in line with the traditional scientific format.

In light of your comment, we have revised our study objectives to clearly delineate our aims and dispel any confusion. The hypotheses have been reformulated into objective statements that clearly chart the course of our investigation and lay the groundwork for operationalization and empirical testing. We believe these adjustments will elucidate the intent and scope of our research, ensuring that our objectives are more precise and methodologically robust.

We are grateful for the opportunity to integrate your invaluable feedback, which has undoubtedly enriched the framework of our research. We trust that these revisions will meet with your approval and will elevate the quality of our study. The pertinent revisions can be referenced on lines 107-112.

-remove the word contemporary and rephrase the sentence.

Response: Thank you for your suggestion. We have removed the word "contemporary" and rephrased the sentence to better reflect our intended meaning. The revised sentence maintains the essence of the original statement while ensuring clarity and conciseness. We appreciate your attention to detail and agree that this modification improves the manuscript. Please see the revised sentence on line 109 of the updated document.

Methods:

- "The scales used in the" do you mean questionnaire? replace.

Response: Thank you for your comment. Indeed, when we referred to "the used scales," we were specifically alluding to the scales within the questionnaire. We have made the necessary correction in the text to express this unambiguously. The term "scales" previously mentioned in the text has now been replaced with "questionnaire." Please refer to line 122 in the revised manuscript for this correction. We appreciate your meticulous review and valuable feedback.

- "effective rate of 78%." change it into response rate.

Response: Thank you for your attentive reading of our manuscript and the suggestion to clarify our terminology. We agree that the term “effective rate of 78%” could be misunderstood and that “response rate” is more appropriate and commonly utilized in this context.

We have updated the manuscript to reflect this change. The phrase “effective rate of 78%” has now been revised to “response rate of 78%” to ensure clarity and align with standard research terminology.

Please refer to the updated line 131 in the revised manuscript where this correction has been applied.

We appreciate your valuable input and believe that this modification improves the accuracy and readability of our study.

- "Given that the total population is 48,209 people" the total population of all university students in China, or in that university or what? if you have the reference that will be great.

Response: Thank you very much for your question. The total population of 48,209 people mentioned here refers to the total number of enrolled students at Yangzhou University as of 2023, not the total number of university students in China. You can find the relevant information on the total number of students on the official website of Yangzhou University, which is http://www.yzu.edu.cn/xxgk/xxjj.htm. We apologize for not making this clear in our previous description in the article, and we have made the necessary revisions in the revised manuscript. Please refer to the updated line number 135.

Research Findings

- please include a table about demographic data of the participants.

Response: Thank you for your inquiry. I can confirm that the demographic data of the participants is indeed included in the article. We have organized this information into three sections: gender, academic level, and age. Please refer to line 128 for the relevant revisions.

- Also, I think you have to put a descriptive statistics to all the variables, in continuous and categorical format before going into analysis. This will answer the research hypothesis number 1 in your research.

Response: Thank you very much for your query. We have indeed classified the variables in the scale into their respective categories. For more detailed information, please refer to the revised manuscript at lines 157-158, 173-174, and 186. We believe this classification aligns with the requirements to adequately address research hypothesis number 1.

- Table 1 design is little confusing, I wish you can adjust it so it can be read easily. For example, you have in the row three sections total, gender and academic year, so please make that clear.

Response: Thank you for your meticulous review and valuable suggestions. We have made a series of improvements to Table 1 as per your guidance. Firstly, we have enhanced the distinction among the various categorization fields, ensuring that the “Total,” “Gender,” and “Grade Level” sections are clear and well-differentiated. Additionally, to further improve the table’s conciseness and readability, we have removed the “Age Group” information.

Please review the revised manuscript at your convenience. We highly value your feedback and hope that our modifications meet your approval.

We are sincerely grateful for your contribution to our work and look forward to your response.

- Table 2 is so confusing with the numbers, please either change the layout, or use 1 or 2 decimals maximum in the table. Remove F-value, as it is confusing.

Response: Thank you very much for your feedback. In reviewing Table 2, we noticed that it did not list the F-values; hence, we presume you might be referring to the issue with the F-values in Table 3. Following your suggestion, we have removed the F-values from Table 3 and adjusted the numeric values to two decimal places for increased clarity and conciseness.

We hope these changes address your concerns and enhance the readability of the data presentation. For details on the revisions, please refer to line number 225.

Thank you again for your valuable comments.

- In Table 4 please put footnote for what model 1 include, and what model 2 include.

Response: Thank you for inquiring about the contents of Table 4. As per your request, we will ensure the provision of appropriate footnotes detailing the components of Model 1 and Model 2 to enhance the clarity of our analysis for the reader's comprehension. We will make certain that these details are succinctly summarized in the footnotes to aid readers in better understanding the composition and outcomes of the models in our study. For specific modifications, please refer to lines 253-255.

- In Table 4 please clarify if you used the data in its continuous format or categorical one, because that was not clear to reader.

Response: Thank you very much for your inquiry regarding the nature of the data used in Table 4. To clarify, the data presented in Table 4 have been processed as categorical variables. We are extremely grateful for your attention to detail and understand the importance of clarifying this to our readers. To eliminate any ambiguity, we will revise the manuscript to explicitly state that the variables in Table 4 have been analyzed as categorical variables. We will make the necessary changes at lines 234-235 of the manuscript.

Discussion:

- "previous studies[16]." in what country?

Response: Thank you for your question regarding “previous studies[16].” I realize the importance of providing the geographic context of referenced studies for the reader’s understanding.

In response to your query, the previous studies mentioned are based in the United States. To clarify this in our manuscript, we have now included the country where the referenced research was conducted. You can find this update in lines 273-274 of the manuscript.

I appreciate your keen eye for detail and the opportunity to make our manuscript as informative and precise as possible.

-"Trevor Egli MS" do you mean that this is reference 16 please put the reference here.

Response: Thank you for your question, and I apologize for the oversight. I have now corrected the placement of the reference. Please see line 278 in the manuscript for the specific citation.

- In discussion from line 248-258, they were written without reference, if this is the author opinion, I think you should write, it is suggested or similar terms. This is applied to many parts in the discussion, where many sentences without reference. So I suggest that write what make it clear that this is your suggestion

Response: Thank you for your feedback. I understand your concerns regarding the lack of references for certain opinions expressed between lines 248-258 of the discussion section. I will take your suggestion and make it clear that these are our suggestions or personal viewpoints. I will address this issue throughout the relevant parts of the discussion to avoid confusion for the readers. For sentences without references, I will add phrases such as "we suggest" or "based on our observation" to clearly indicate that it reflects the authors' perspectives. Once again, I appreciate your valuable comments. For specific modifications, please refer to the manuscript lines 278-279 and 296-297.

- Your discussion is long, and I think you need to make subheading for it.

Response:Thank you for your constructive feedback on the discussion section of our manuscript. I appreciate your suggestion to incorporate subheadings to improve the readability and structure of our text.

I agree that the discussion section is rich in content, and adding subheadings will help readers better navigate and understand the various arguments and conclusions we have presented. We will revise this part by adding relevant subheadings that reflect the core points and themes of our discussion. Such restructuring will undoubtedly make the content more understandable and focused.

We will ensure that each subheading is short and descriptive, allowing readers to quickly grasp the main idea of the subsequent paragraphs. We believe these changes will enhance the overall clarity of the manuscript, and we thank you for pointing this out.

For specific modifications, please refer to lines 272-273, 319-320, 360-361, 398, and 411 of the manuscript.

Attachment

Submitted filename: Response to Reviewer.docx

pone.0307162.s003.docx (22.1KB, docx)

Decision Letter 2

Sohel Ahmed

9 May 2024

PONE-D-23-21239R2Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise BehaviorPLOS ONE

Dear Dr. Li,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 23 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

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Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #5: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #5: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #5: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #5: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #5: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: This study examined the effect of smartphone addiction on college students' sleep quality: the moderating effect of physical exercise behavior. The corrections I requested have been made, thank you.

Reviewer #5: Thank you very much for the possibility to review the study "Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise Behavior". The work is interesting and the revisions carried out have allowed an improvement of the work. I think it has improved significantly. At the same time, however, there are some aspects that should be improved. In particular, the authors focused on university students, highlighting the association between smartphone addiction and the quality of sleep. It would be useful to be able to discuss the results of the study (but also an in-depth analysis in the introductory part) of the evolutionary phase in which the participants of the study find themselves. In particular, there is a large literature on emerging adulthood that should be explored in order to better understand the results of the study. Some specific studies are recommended:

- Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for?. Child development perspectives, 1(2), 68-73.

- Ballarotto, G., Marzilli, E., Cerniglia, L., Cimino, S., & Tambelli, R. (2021). How does psychological distress due to the COVID-19 pandemic impact on internet addiction and Instagram addiction in emerging adults?. International journal of environmental research and public health, 18(21), 11382.

- Hochberg, Z. E., & Konner, M. (2020). Emerging adulthood, a pre-adult life-history stage. Frontiers in endocrinology, 10, 918.

- Tambelli, R., Cimino, S., Marzilli, E., Ballarotto, G., & Cerniglia, L. (2021). Late adolescents’ attachment to parents and peers and psychological distress resulting from COVID-19. A study on the mediation role of alexithymia. International Journal of Environmental Research and Public Health, 18(20), 10649.

- Griffioen, N., Scholten, H., Lichtwarck-Aschoff, A., Van Rooij, M., & Granic, I. (2021). Everyone does it—differently: A window into emerging adults’ smartphone use. Humanities and Social Sciences Communications, 8(1), 1-11.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

Reviewer #5: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Jul 26;19(7):e0307162. doi: 10.1371/journal.pone.0307162.r006

Author response to Decision Letter 2


16 May 2024

Reviewer #3: This study examined the effect of smartphone addiction on college students' sleep quality: the moderating effect of physical exercise behavior. The corrections I requested have been made, thank you.

Response: Thank you for your feedback. I am pleased to confirm that the necessary corrections have been made. Should you have any further queries or require additional clarifications, please feel free to contact us.

Reviewer #5: Thank you very much for the possibility to review the study "Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise Behavior". The work is interesting and the revisions carried out have allowed an improvement of the work. I think it has improved significantly. At the same time, however, there are some aspects that should be improved. In particular, the authors focused on university students, highlighting the association between smartphone addiction and the quality of sleep. It would be useful to be able to discuss the results of the study (but also an in-depth analysis in the introductory part) of the evolutionary phase in which the participants of the study find themselves. In particular, there is a large literature on emerging adulthood that should be explored in order to better understand the results of the study. Some specific studies are recommended:

- Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for?. Child development perspectives, 1(2), 68-73.

- Ballarotto, G., Marzilli, E., Cerniglia, L., Cimino, S., & Tambelli, R. (2021). How does psychological distress due to the COVID-19 pandemic impact on internet addiction and Instagram addiction in emerging adults?. International journal of environmental research and public health, 18(21), 11382.

- Hochberg, Z. E., & Konner, M. (2020). Emerging adulthood, a pre-adult life-history stage. Frontiers in endocrinology, 10, 918.

- Tambelli, R., Cimino, S., Marzilli, E., Ballarotto, G., & Cerniglia, L. (2021). Late adolescents’ attachment to parents and peers and psychological distress resulting from COVID-19. A study on the mediation role of alexithymia. International Journal of Environmental Research and Public Health, 18(20), 10649.

- Griffioen, N., Scholten, H., Lichtwarck-Aschoff, A., Van Rooij, M., & Granic, I. (2021). Everyone does it—differently: A window into emerging adults’ smartphone use. Humanities and Social Sciences Communications, 8(1), 1-11.

Response: we thank you for your detailed review and valuable suggestions on our research. Based on your feedback, we have conducted an in-depth analysis of the introduction section and integrated the literature you recommended to enhance our understanding and background of the study topic. These revisions not only deepened the theoretical depth of our paper but also provided a more solid theoretical foundation for our research findings. Once again, thank you for your careful guidance and suggestions, which have been critical in enhancing the quality and depth of our study. Please refer to lines 59-73, 325-330, 442-447, and 452-453 of the article for specific modifications.

Attachment

Submitted filename: Response to Reviewers.docx

pone.0307162.s004.docx (17.5KB, docx)

Decision Letter 3

Sohel Ahmed

2 Jul 2024

Influence of Smartphone Addiction on Sleep Quality of College Students: The Regulatory Effect of Physical Exercise Behavior

PONE-D-23-21239R3

Dear Dr. Bo li

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Sohel Ahmed, BPT, MPT, MDMR

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #6: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #6: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #6: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #6: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #6: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: In this study, they examined the effect of smartphone addiction on the sleep quality of university students. Thanks for the corrections. .

Reviewer #6: Thank you, authors, for revising the manuscript in response to reviewer comments and queries. The manuscript has been improved satisfactorily.

The English language has been revised to make it more understandable. However, there is scope for further editing.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

Reviewer #6: No

**********

Acceptance letter

Sohel Ahmed

17 Jul 2024

PONE-D-23-21239R3

PLOS ONE

Dear Dr. Li,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Sohel Ahmed

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Data

    (SAV)

    pone.0307162.s001.sav (170KB, sav)
    Attachment

    Submitted filename: Response to Reviewers.docx

    pone.0307162.s002.docx (157.5KB, docx)
    Attachment

    Submitted filename: Response to Reviewer.docx

    pone.0307162.s003.docx (22.1KB, docx)
    Attachment

    Submitted filename: Response to Reviewers.docx

    pone.0307162.s004.docx (17.5KB, docx)

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting information files.


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